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November 28, 2017

CMS to expand MA value-based insurance design model in 2019

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    CMS on Wednesday announced that in 2019 it will expand the Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) to include an additional 15 states, Modern Healthcare reports.

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    About the MA VBID model

    The MA VBID model allows MA insurers to lower beneficiaries' out-of-pocket costs as a way to encourage them to use high-quality services and potentially reduce overall costs in the long term. CMS launched the five-year program in January. The program currently is open to MA insurers in:

    • Arizona;
    • Indiana;
    • Iowa;
    • Massachusetts;
    • Oregon;
    • Pennsylvania; and
    • Tennessee.

    Starting Jan. 1, 2018, the program will be available to insurers in Alabama, Michigan, and Texas.

    The program allows insurers to take one of four approaches when designing a plan:

    • Eliminate or lower cost-sharing for high-value health care providers;
    • Eliminate or lower cost-sharing for high-value services and items, including some Medicare Part D drugs;
    • Lower cost-sharing for beneficiaries who participate in disease-management programs; or
    • Provide full coverage for supplemental benefits, including telemedicine services for diabetes management and tobacco cessation, for some populations. 

    CMS announces MA VBID updates for 2019

    CMS on Wednesday announced that in 2019 it will expand the MA VBID model to include 15 additional states:

    • California;
    • Colorado;
    • Florida;
    • Georgia;
    • Hawaii;
    • Maine;
    • Minnesota;
    • Montana;
    • New Jersey;
    • New Mexico;
    • North Carolina;
    • North Dakota;
    • South Dakota;
    • Virginia; and
    • West Virginia.

    In addition, CMS said beginning in 2019 it will allow Chronic Condition Special Needs Plans to participate in the program. Further, CMS said in 2019 it will allow participating insurers to propose their own methods or systems for identifying eligible enrollees, including Medicare beneficiaries with chronic conditions different than the ones CMS focused on during the program's first year.

    CMS said current and new participants can apply to be a part of the 2019 VBID model until Jan. 26, 2018 (Livingston, Modern Healthcare, 11/22; Haefner, Becker's Hospital Review, 11/22; AHA News, 11/22; CMS release, 11/22).

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